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Breast Cancer Research : BCR 2005
Topics: Breast Neoplasms; Computer Simulation; Female; Humans; Mass Screening; Reproducibility of Results
PubMed: 16168144
DOI: 10.1186/bcr1321 -
BMJ (Clinical Research Ed.) Sep 2003To determine the effectiveness of programmes of screening in general practice for excessive alcohol use and providing brief interventions. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To determine the effectiveness of programmes of screening in general practice for excessive alcohol use and providing brief interventions.
DESIGN
Systematic review and meta-analysis of randomised controlled trials that used screening as a precursor to brief intervention.
SETTING
General practice.
MAIN OUTCOME MEASURES
Number needed to treat, proportion of patients positive on screening, proportion given brief interventions, and effect of screening.
RESULTS
The eight studies included for meta-analysis all used health questionnaires for screening, and the brief interventions included feedback, information, and advice. The studies contained several sources of bias that might lead to overestimates of the effects of intervention. External validity was compromised because typically three out of four people identified by screening as excessive users of alcohol did not qualify for the intervention after a secondary assessment. Overall, in 1000 screened patients, 90 screened positive and required further assessment, after which 25 qualified for brief intervention; after one year 2.6 (95% confidence interval 1.7 to 3.4) reported they drank less than the maximum recommended level.
CONCLUSIONS
Although even brief advice can reduce excessive drinking, screening in general practice does not seem to be an effective precursor to brief interventions targeting excessive alcohol use. This meta-analysis raises questions about the feasibility of screening in general practice for excessive use of alcohol.
Topics: Alcoholism; Bias; Family Practice; Humans; Mass Screening; Prognosis; Psychotherapy, Brief; Randomized Controlled Trials as Topic; Risk Reduction Behavior
PubMed: 12958114
DOI: 10.1136/bmj.327.7414.536 -
CA: a Cancer Journal For Clinicians 2008Each year the American Cancer Society (ACS) publishes a summary of its recommendations for early cancer detection and a summary of the most current data on cancer... (Review)
Review
Each year the American Cancer Society (ACS) publishes a summary of its recommendations for early cancer detection and a summary of the most current data on cancer screening rates and trends in US adults. In 2007, the ACS updated its colorectal cancer screening guidelines in a collaborative effort with the US Multi-Society Task Force and the American College of Radiology. In this issue of the journal, we summarize the current ACS guidelines, provide an update of the most recent data pertaining to participation rates in cancer screening from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System and the National Health Interview Survey, and address some issues related to access to care.
Topics: American Cancer Society; Humans; Mass Screening; Neoplasms; Practice Guidelines as Topic; United States
PubMed: 18443206
DOI: 10.3322/CA.2007.0017 -
Drug and Alcohol Dependence Sep 2019There is a strong rationale for clinicians to identify risky drinking among young people given the harms caused by alcohol. This systematic review evaluates the quality... (Meta-Analysis)
Meta-Analysis
BACKGROUND
There is a strong rationale for clinicians to identify risky drinking among young people given the harms caused by alcohol. This systematic review evaluates the quality of evidence in the validation literature on alcohol screening and assessment measures for young people under 25.
METHODS
Six electronic databases (MEDLINE; EMBASE; PsycINFO; SSCI; HMIC; ADAI) were searched in May 2016 for published and grey literature. Full-text reports published in English since 1980 were included if they aimed to validate an alcohol screening or assessment measure in comparison with a previously validated alcohol measure. Risk of bias was assessed in studies surpassing a priori quality thresholds for predictive validity, internal and test-retest reliability using COSMIN and QUADAS-2.
RESULTS
Thirty nine reports comprising 135 discrete validation studies were included. Summary estimates indicated that the screening instruments performed well - AUC 0.91 (95% CI: 0.88 to 0.93); sensitivity 0.98 (0.95 to 0.99); specificity 0.78 (0.74 to 0.82). Noting a paucity of validation evidence for existing assessment instruments, aggregated reliability estimates suggest a reliability of 0.81 (0.78 to 0.83) adjusted for 10 items. Risk of bias was high for both types of studies.
CONCLUSIONS
The volume and quality of available evidence are superior for screening measures. It is recommended that clinicians use alcohol frequency or quantity items if asking a single question. If there is an opportunity to ask more questions either the 3-item AUDIT-C or the 10-item AUDIT are recommended. There is a need to develop new instruments to assess young people's alcohol-related problems.
Topics: Adolescent; Alcohol Drinking; Alcohol-Related Disorders; Female; Humans; Male; Mass Screening; Reproducibility of Results; Validation Studies as Topic; Young Adult
PubMed: 31299552
DOI: 10.1016/j.drugalcdep.2019.01.030 -
Journal of Gastrointestinal and Liver... Jun 2020
Topics: Global Burden of Disease; Global Health; Health Services Needs and Demand; Humans; Life Style; Liver Cirrhosis; Mass Screening; Non-alcoholic Fatty Liver Disease; Prevalence; Preventive Health Services; Prognosis; Risk Factors
PubMed: 32530977
DOI: 10.15403/jgld-1463 -
Journal of General Internal Medicine Jul 2004To identify potential obstacles to bone mineral density (BMD) testing, we performed a structured review of current osteoporosis screening guidelines, studies of BMD... (Review)
Review
OBJECTIVES
To identify potential obstacles to bone mineral density (BMD) testing, we performed a structured review of current osteoporosis screening guidelines, studies of BMD testing patterns, and interventions to increase BMD testing.
DESIGN
We searched medline and HealthSTAR from 1992 through 2002 using appropriate search terms. Two authors examined all retrieved articles, and relevant studies were reviewed with a structured data abstraction form.
MEASUREMENTS AND MAIN RESULTS
A total of 235 articles were identified, and 51 met criteria for review: 24 practice guidelines, 22 studies of screening patterns, and 5 interventions designed to increase BMD rates. Of the practice guidelines, almost one half (47%) lacked a formal description of how they were developed, and recommendations for populations to screen varied widely. Screening frequencies among at-risk patients were low, ranging from 1% to 47%. Only eight studies assessed factors associated with BMD testing. Female patient gender, glucocorticoid dose, and rheumatologist care were positively associated with BMD testing; female physicians, rheumatologists, and physicians caring for more postmenopausal patients were more likely to test patients. Five articles described interventions to increase BMD testing rates, but only two tested for statistical significance and no firm conclusions can be drawn.
CONCLUSIONS
This systematic review identified several possible contributors to suboptimal BMD testing rates. Osteoporosis screening guidelines lack uniformity in their development and content. While some patient and physician characteristics were found to be associated with BMD testing, few articles carefully assessed correlates of testing. Almost no interventions to improve BMD testing to screen for osteoporosis have been rigorously evaluated.
Topics: Bone Density; Densitometry; Female; Humans; Male; Mass Screening; Osteoporosis; Practice Guidelines as Topic
PubMed: 15209594
DOI: 10.1111/j.1525-1497.2004.30240.x -
Journal of General Internal Medicine Oct 2018Use of breast cancer screening is influenced by factors associated with patients, primary care providers, practices, and health systems.
BACKGROUND
Use of breast cancer screening is influenced by factors associated with patients, primary care providers, practices, and health systems.
OBJECTIVE
We examined the relative effects of these nested levels on four breast cancer screening metrics.
DESIGN
A web-based survey was completed at 15 primary care practices within two health systems representing 306 primary care providers (PCPs) serving 46,944 women with a primary care visit between 1/2011-9/2014. Analyses occurred between 1/2017 and 5/2017.
MAIN MEASURES
Across four nested levels (patient, PCP, primary care practice, and health system), frequency distributions and adjusted rates of primary care practice characteristics and survey results for four breast screening metrics (percent screened overall, and percent screened age 40-49, 50-74, and 75+) were reported. We used hierarchical multi-level mixed and random effects analysis to assess the relative influences of PCP, primary care practice, and health system on the breast screening metrics.
KEY RESULTS
Overall, the proportion of women undergoing breast cancer screening was 73.1% (73.4% for ages 40-49, 76.5% for 50-74, and 51.1% for 75+). Patient ethnicity and number of primary care visits were strongly associated with screening rates. After adjusting for woman-level factors, 24% of the overall variation among PCPs was attributable to the primary care practice level, 35% to the health system level, and 41% to the residual variation among PCPs within practice. No specific provider-level characteristics were found to be statistically significant determinants of screening rates.
CONCLUSIONS
After accounting for woman-level characteristics, the remaining variation in breast cancer screening was largely due to provider and health system variation.
Topics: Adult; Aged; Aged, 80 and over; Breast Neoplasms; Early Detection of Cancer; Female; Health Care Surveys; Humans; Mammography; Mass Screening; Massachusetts; Middle Aged; New Hampshire; Primary Health Care; Professional Practice
PubMed: 30076569
DOI: 10.1007/s11606-018-4560-1 -
The Pan African Medical Journal 2020Cervical cancer may be fatal to women if not identified and treated early. The importance of organised cervical screening has been felt in many developed countries....
Cervical cancer may be fatal to women if not identified and treated early. The importance of organised cervical screening has been felt in many developed countries. However, the majority of women in developing countries may be under-screened or may have never been screened because many developing countries have not developed a national cervical cancer prevention program accessible to all women due to reasons such as competing funding priorities, low prioritization of cervical cancer and cultural practices across Africa. It is important that these factors are adequately addressed to improve access to regular cervical screening services and ultimately help curb the incidence and impact of cervical cancer on women in sub-Saharan Africa.
Topics: Africa South of the Sahara; Early Detection of Cancer; Female; Health Services Accessibility; Humans; Mass Screening; Uterine Cervical Neoplasms
PubMed: 32774656
DOI: 10.11604/pamj.2020.36.97.19071 -
Biometrics Mar 2019For disease screening, group (pooled) testing can be a cost-saving alternative to one-at-a-time testing, with savings realized through assaying pooled biospecimen (eg,...
For disease screening, group (pooled) testing can be a cost-saving alternative to one-at-a-time testing, with savings realized through assaying pooled biospecimen (eg, urine, blood, saliva). In many group testing settings, practitioners are faced with the task of conducting disease surveillance. That is, it is often of interest to relate individuals' true disease statuses to covariate information via binary regression. Several authors have developed regression methods for group testing data, which is challenging due to the effects of imperfect testing. That is, all testing outcomes (on pools and individuals) are subject to misclassification, and individuals' true statuses are never observed. To further complicate matters, individuals may be involved in several testing outcomes. For analyzing such data, we provide a novel regression methodology which generalizes and extends the aforementioned regression techniques and which incorporates regularization. Specifically, for model fitting and variable selection, we propose an adaptive elastic net estimator under the logistic regression model which can be used to analyze data from any group testing strategy. We provide an efficient algorithm for computing the estimator along with guidance on tuning parameter selection. Moreover, we establish the asymptotic properties of the proposed estimator and show that it possesses "oracle" properties. We evaluate the performance of the estimator through Monte Carlo studies and illustrate the methodology on a chlamydia data set from the State Hygienic Laboratory in Iowa City.
Topics: Algorithms; Chlamydia Infections; Computer Simulation; Data Interpretation, Statistical; Humans; Mass Screening; Monte Carlo Method; Regression Analysis
PubMed: 30267535
DOI: 10.1111/biom.12973 -
BMJ Open Quality Mar 2020The goal of the University of California Davis Health Blood Pressure (BP) Quality Improvement Initiative was to improve the diagnosis, management and control of high BP....
The goal of the University of California Davis Health Blood Pressure (BP) Quality Improvement Initiative was to improve the diagnosis, management and control of high BP. Patients aged 18-85 years were included in the initiative. Lean A3 problem solving was used to implement the following evidence-based interventions based on stakeholder interviews, value stream mapping and the Centers for Disease Control and Prevention's Million Hearts Initiative: staff training on accurate BP measurement, visual cues and reminders for BP screening, virtual case-based videoconferences, standardised clinical management algorithm, academic detailing visits, clinical decision support tools, access to pharmacists for medication comanagement, clinician workflow modification, patient education and access to home BP monitors. Following implementation of interventions, accurate screening of BP increased from 14% to 87% and BP control increased from 62% to 75%. Strategies that contributed the most to improvements were using a team-based approach, adjusting clinic workflow and frequent communication of results to staff.
Topics: Academic Medical Centers; Adolescent; Adult; Aged; Blood Pressure Determination; California; Female; Humans; Hypertension; Male; Mass Screening; Middle Aged; Quality Improvement
PubMed: 32213548
DOI: 10.1136/bmjoq-2018-000614